Episode #1: Don’t Be A Lemming. Why Integration Fails So Many Docs

Published: December 12, 2019

https://www.youtube.com/watch?v=tllDFJInKrk

Show Notes:

Speaker 1: (00:00)
Welcome everybody. This is Dr. Andrew Wells from the simplified integration podcast. It's great to have you here. You're on episode one of one. Don't be a lemming. Why integration fails so many doctors.

Speaker 2: (00:17)
Leonardo da Vinci once said that simplicity is the ultimate sophistication and I agree. You see the problem with the way that most consulting groups approach medical integration is anything but simple. In fact, it's the exact opposite. It's expensive, it's complicated and quite frankly it's exhausting. Enough is enough. There are far too many amazing integrated clinics that are struggling. Well, I'm on a mission to change that. What I've come to find from over five years working with integrated practices is that simplicity really is the secret. The old saying of less is more is true. Through a streamlined approach, I was able to create multiple successful seven figure integrated clinics and now I'm going to show you how you can do the same. Join me as I share with you the secrets to successful medical integration and practice growth. Join me on a journey to greater sophistication through innovation. I'm Dr. Andrew Wells and welcome to the simplified integration podcast.

Speaker 1: (01:13)
All right doc. So welcome to episode one. This is actually part of a mini series, a five-part mini series called the seven figure shortcut. So this is kind of like a series within a series. And the reason I want to make this five part series is because I wanted to give doctors not only a background on what they should avoid and the common mistakes of chiropractors make, but I also wanted to provide you with an amazing amount of con content that you can use today to start having wins and not just content that you can use. But you know, most doctors when they're, when they're, when they have a vision for what their practice looks like, they don't right away jump into that practice model without doing research, without asking questions, without going through this like battle in your head. And is this good for my practice?

Speaker 1: (01:53)
Is a good for my business? Is it good for my patients? So what you to learn from my background, I've been doing integration now for five years. I've helped dozens of doctors, uh, have opened several successful businesses. And so I've had all the failures. I've also had a lot of successes. And when I'm, when I'm on this podcast, this is really a platform for me to be very real, very transparent, transparent, very upfront with you because I'm not here to hide anything, uh, because my past is not perfect and I want to use my past so that you guys don't make the same mistakes. And, uh, you know, we've had for as much success as we've had, we've also had some pretty miserable failures. And that's the whole concept and idea of this podcast. So let me dive right in and I want to give you a background on how integration crept into my life now.

Speaker 1: (02:41)
My wife and I. So we, we found the concept of integration really exciting and really sexy. And we were two years into practice and my wife and I had, we started a practice from scratch and we were working really, really hard to make that thing go. And so we were, you know, we, we grew pretty quickly. We're, uh, you know, anywhere from a 250 to 350 a week office, which I think in two years was pretty good. And to get there we had to do tons of screenings. We did tons of talks. If, if there was an opportunity to talk about chiropractic somewhere in my community, I was there. That means I was there in my lunch breaks in the evenings on the weekends. You know, we typically worked, uh, at bare minimum, you know, a six and a half, uh, six to six and a half a day work week because we were just putting so much effort behind opening our practice and getting it off the ground.

Speaker 1: (03:35)
And it went really well. And two years into that, you know, this, these thoughts started creeping in my head, I'm like, can I really maintain this level of effort for the next 30 years of practice? And I don't know if you, if you're listening to this, if you've ever had that thought like, can I really sustain? Do I really want to be doing this when I'm 50, 60, maybe even 70 years old? Like, I don't know if I can do that. And at that time, a friend of mine who had a, I didn't know this, but he had integrated about a year before, uh, before we talked. And he approached me and said, Hey, Andrew, uh, it looks like you're doing well in practice. Um, I don't know if you've ever heard of integration, but I found this practice model, it's fantastic. Like it's really great. I think you'd be interested in it.

Speaker 1: (04:16)
So it was my friend who, who was also a consultant, uh, introduced me to this idea and I thought like, man, it was, this sounded like a really good idea because he, the way he presented it was this, um, integration is, is great because instead of relying on chiropractic re, uh, insurance reimbursement. So by the way, I'm in a state where we get barely any chiropractic reimbursement from insurance. And so we were like an 85, 90% cash practice at the time. And he said, instead of using chiropractic insurance, you can start using their medical insurance benefits. So what that means, it's a lower deductible. It's a lower copay, it's a lower cost per patient, but in return you're getting much higher insurance reimbursement because you're billing for medical services. And I'm like, Oh, that's actually a really good idea. And he said, by the way, on top of that is you're positioning your office as a medical office, not just a chiropractic office.

Speaker 1: (05:13)
And I don't mean this as like an insult to chiropractors, but you know what I mean. Like if you look at the hierarchy of, uh, of like, um, uh, reputation and esteem and integrity and whatever you want to call it, if you ask like anyone on the street, if you go to the gas station and the grocery store, like who do you, who do you trust and respect more? A medical doctor or a chiropractor, 70, I don't know what the, but most people would say, yeah, I trust a medical doctor more than a chiropractor. As sad as that sounds like, I know it's a lot of BS, but that's really where we are in our culture. And he goes, so when you position yourself as a medical office, when you're integrated, you get rid of a lot of that, like a, that preconceived notion of what chiropractic is and what it isn't.

Speaker 1: (05:53)
So you're positioning yourself, uh, as a more valuable office when you integrate. And I thought like that. Okay. That made a lot of sense. And uh, and so, and also you said, all right, so now, so you've got those two things. You have higher reimbursement, you have better authority in your practice, but you also have a bunch of other things that you can bill for. So not just adjustment and rehab. You can bill for, you know, trigger point injections and durable medical equipment and ultrasound guided injections and STEM cell therapy and like the NCV test and these, all these different things that you can now tap into as an integrated office. And I remember thinking like, yeah, that's kinda cool from a business standpoint. But that was the, that was the first time. And I remember thinking this, I'm like, yeah, but like, that's not chiropractic.

Speaker 1: (06:37)
And something like, hit me here. And I'm like, mm. Like, I don't know if I'm going to open that door, right? Like I almost felt like even thinking about it was kind of selling out my practice and my patients and my philosophy on chiropractic. So I was, this was the, this was the argument in my head. I can stay chiropractic and do what I'm doing, which I was doing relatively successfully and do that for the next 30 years. Or my other option was I can integrate and the downs. So the integration would be I make more money, I have more time. And the only bad thing was like, I feel like I'm kind of selling my soul a little bit. And I don't know if that resonates with anybody listening, but that's how I felt that at the time. And I really, really didn't want to be like, look back 20 years from now and feel like I remain kind of this mom and pop shop.

Speaker 1: (07:29)
Like I didn't reach my full potential. And that was like the turning point in my, in my mind. Like, okay, I need to do integration. And, um, and so those little door, I felt like this little door opened up inside of me that I just kind of opened up Pandora's box. I had the feeling, I didn't know why I felt that way, but I just felt like this could go wrong if I, if I let it go wrong. But I was, I was determined to make it go the right way and to serve my patients the best way possible and also to grow and expand my practice, uh, for, for, for financial reasons to be honest. And so we, we integrated our practice and, uh, we hired a consultant and he told me right out of the gate, this is going to be hard. And I really appreciated his honesty cause it was really hard.

Speaker 1: (08:10)
And you know, you said it's going to take anywhere from 70,000 to a hundred thousand dollars to get this thing started. So I had this chunk of money saved up for integration. I said, okay, if it's gonna take 70 to a hundred thousand bucks to get started, I better have some cushion in case things go wrong. So I had about 200,000 I doubled that number. Worst case scenario, I had 200K saved up in a bank account to make this new integrated model go smoothly. So we started the process, we integrated and uh, I thought it was going to take about about three to six months to uh, to get credentialed. And this is important because if you're not credentialed with blue cross blue shield and United and Medicare, you're screwed because you've now introduced this really like high overhead model and if you don't have any insurance checks coming in, like you're going to run out of money pretty quickly.

Speaker 1: (08:55)
And, and that is exactly what happened to us. So we integrated and we were waiting for credentialing. Month one goes by, month two goes by, month three, four, five, six months go by and we're waiting and waiting and waiting for credentialing to happen. And we heard crickets and this was like my wife and I would like, we would like be waiting for the mailman to show up with insurance checks and like calling blue cross blue shield. Like where, where, where are we in the process? And they had no answers for us. And then we were this close, this close to running out of money, like we went through our entire bank account. That 200 K was gone in a really short amount of time. And we're like, what are we going to do? Like we almost shut down the whole operation and then finally answered prayer.

Speaker 1: (09:39)
We finally got credentialed. So insurance money started coming in. So that was a huge relief. Uh, I think I, I have like five gray hairs. I think Justin, that from that moment alone and then the real work started. So when you integrate, if you're not aware, if you've ever been to an integrated office, you have to hire a medical doctor, nurse practitioner. We hired like three more staff members just to run these new therapies. And so all of a sudden our staff increased, our patient volume, increased, our care plans became a lot more complicated and we're like, so the very thing that we were trying to do and in create like a stable financial business model to have some practice freedom and to make more money and I sort of free ourselves from, from like the day to day to day grind became a lot more complicated. So we were told up front, this is going to be like a turnkey system, just get it up and running, it's going to be successful.

Speaker 1: (10:31)
But we actually found that our life was a lot simpler when we just did chiropractic. Not only was it a lot simpler, it was actually a lot more profitable. Now there were, there were times or sure we uh, we made a lot of money in integration, but there were also times when we didn't make a lot of money in integration. So about two years into the process, you know, we're cranking for one of the busiest integrated offices in the country. Uh, we started to get letters from blue cross blue shield saying, Hey, you're doing too many trigger point injections. It's abnormal for your office in your area to do, be doing that many that many, uh, trigger point injections. Same thing for durable medical equipment. Same thing for NCV tests. So the big insurance companies started saying, Hey, we're paying these guys way too much money for what they're doing.

Speaker 1: (11:16)
And they started slashing our reimbursement and in some cases they just cut reimbursement com completely. So what went from a pretty lucrative business model all of a sudden completely out of our control. We lost a lot of that reimbursement. So imagine this, you go from our overhead, by the way, with 80 to $100,000 per month. So every month we had, you know, we're showing out tons of money, but our revenue was really high as well. But all of a sudden our revenue started dropping and dropping and dropping and dropping until a point where we were breaking even. And then we started losing money and integration and the problem, it's not because we had bad marketing or we are bad business people are bad managers. A problem was you had these big insurance companies who are controlling the game. We are a hundred percent insurance dependent and that's not a good business model to be in because you have no control over that.

Speaker 1: (12:04)
And so what are we going to do? We're going to fight blue cross and blue shield and fight United healthcare. You're not going to win that battle. So I realized like we are, we're just in a, uh, we were in a losing game and it was only a matter of time before we became completely irrelevant. And that took a while for me to sink in. Like I didn't want to, I didn't want to let go of that because we were, by all means successful. But I, I knew intuitively that that was going away. And logically I just didn't know what else to do. And we found ourselves stuck in this really complicated, very expensive, overwhelming and exhausting business model. So this was this huge ride that we took with integration. And I remember having this conversation with my wife, like, should we just quit this?

Speaker 1: (12:49)
And like we didn't know what else to do. We didn't want to go back to chiropractic only because that kind of left us in the same position, but we really felt stuck. We didn't know where to go. And, uh, I think a lot of doctors I've talked to so many doctors who are in this exact same position, um, you know, they, they started integration for the same reasons I did. They wanted to help more patients, want to make more money, wanting to feel like they were, uh, working on their business and not in their business and the end up, um, no fault of their own. Just as you know, being in the insurance model, being a victim of medical integration. And there's a huge issue right now and this really, really bothers me, uh, is you have these like big management companies who are still 100% promoting that old business model.

Speaker 1: (13:38)
This, I and I will argue this was a great business model five and 10 years ago and you can find like there are so many docs who made millions of dollars doing this and helped a lot of people. But that business model is dead. And if it's just happening in chiropractic, this is happening in integrated offices. This is also happening in the MD world. Ask your primary care physician if they're making the same money money today as they were 10 years ago. It's just this is nationwide. And as healthcare changes more and more and more, and as insurance companies have a stronger control over this industry, it's the doctors who suffer. And so I, it really bothers me when when management companies are still selling this dream, the dream is dead. And there are so many, I talked, I've talked to so many doctors that are like, yep, you nailed it on the head.

Speaker 1: (14:22)
I wish, you know, I wish someone had told me that before and this is why we're doing this, this podcast is to, is to show that there are, there are two sides of that story. There's a good side and the bad side. And so as we kind of close up this, this podcast, um, there was a moment in time when we were going through this. I completely changed my life and as all this was, was happening in our offices, um, it was actually the day after Thanksgiving, we woke up, um, it was black Friday. I got the, our car with my family, my two little boys and wife, and we were going to like a, uh, a holiday type event and driving down the road and all of a sudden, bam, we got smashed head-on, going 40 miles an hour. Uh, I broke my neck, broke my shoulder, collapsed lung, broken sternum.

Speaker 1: (15:10)
All of a sudden like this, my life came to a complete halt. Like everything stopped. And, um, I'm sitting in, I remember waking up in the hospital and, um, not really knowing what happened. And I remember the in my friend said, Oh yeah, the, you know, someone died in the accident. Like you're lucky to be alive. And no idea was going on. My family was okay, thank God. But as I was waking up and recovering, um, and realize what the damage was, all of a sudden it kind of sunk in as I'm thinking about our practice, like, Holy cow, what the heck is going to happen to our practice? And I'm like, sure, 100%. Like we've got to close up shop because I can't run it. My wife can't run it. And I'm looking at six months of recovery, ran with a neck brace the whole bit.

Speaker 1: (15:55)
And I'm like, Oh, we're totally screwed. Totally screwed. And you know how like I knew like through prayer and there are people praying for us and kind of building me up during that really dark time and I still get emotional talking about it now. And I remember thinking like, something good is going to come out of this. Like, I know this is happening for a reason. I have total faith that like God put me here for a reason. This is something good is going to come out of this. And I just knew it, I knew it. And um, something really good did come out of it. And it's just, uh, you know, it's amazing where sometimes you just like, you're forced to sit back and do nothing and not be able to work and just kind of sit in your thoughts. I haven't done that in a long, long time, but I was forced to do that.

Speaker 1: (16:35)
And you know, it's funny that you get these ideas and you get these like really, you know, things become really clear and a lot of things became really clear. It became clear that I was, I was on a path that wasn't sustainable. My family was not better off having integrated. I wasn't better off my family. My wife wasn't better off, and it was like it was time for a change. And so, um, uh, on the, on the next, so I'm going to leave you hanging a little bit here. I don't want to tell you exactly what that, uh, aha moment was, but I'm gonna share that with you. But I just want you to think about that. So if you, if you're, um, if you're considering integration, um, and you have some pause about starting that, there's good reason for that. And so, um, yeah.

Speaker 1: (17:21)
So just so in wrapping this up and the next episode, I'm going to tell you exactly what that aha aha moment was. It's a moment that saved my practice life, made life a lot easier for me, for my patients, for my family, and completely changed everything. And I'm, you know, looking back at it, I'm always glad that all that bad stuff happened because it led me to, to finding that discovery. And so I'm really excited to share that with you and we're going to share that on a next episode. So docs, thank you so much for listening. I hope you found this valuable. I hope you can learn from my story and that you find a benefit from it. So I look forward to seeing you and the next episode. Until then. Bye. Bye.

Speaker 2: (18:01)
Hey innovators. Thanks for listening to the simplified integration podcast. The fact that you're listening tells me that you're like me, someone who loves simplicity and the truth is those who embrace simplicity are some of the greatest innovators. So hope you got a ton of value from what we covered on today's episode. Be sure to subscribe and share with other docs that you feel could benefit from greater sophistication through simplification and innovation. If you've got specific questions that you'd like answered on this podcast or you've got specific topics that you'd like me to discuss, just shoot me an email@infoatintegrationsecrets.com that's info@simplifiedintegration.com.

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